Health Information

Depression: Should My Child Take Medicine to Treat Depression?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Depression: Should My Child Take Medicine to Treat Depression?

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Get the facts

Your options

Have your child take medicine for depression.

Don't have your child take medicine. Use counseling or home
treatment to help manage your child's symptoms.

Key points to remember

If your child's symptoms are mild to moderate, counseling or lifestyle
changes may be enough to help your child feel better. But if your child's
symptoms don't improve with counseling, you can add medicine to the
treatment.

If your child's symptoms are severe, a combination of
antidepressants and counseling often works better than if only one of these
treatments is used.

It's normal for a child to be moody or sad from time to time.
But if these feelings last for weeks or months, they may be a sign of
depression.

Stress, family problems, death of a loved one, or
trauma such as violence, abuse, or neglect can cause
depression.

The safety and long-term effects of medicines used to
treat depression in children and teens are not fully known. But experts believe
that the benefits of these medicines outweigh the risks.

If your
child needs to take medicine, help him or her to not feel ashamed about taking
it. Depression is a medical condition, not a character flaw or weakness.
Medicine can help your child feel better.

Depression is a serious mood disorder that can take
the joy from your child's life. It may occur when brain chemicals that affect
your child's mood get out of balance. Stress, family problems, or trauma such
as violence, abuse, or neglect can cause this to happen.

Depression
runs in families. Children and teens who have a parent with depression are more likely to have depression than children whose parents are not
depressed. As many as 2 out of 100 children and 8 out
of 100 teens have serious depression.1

It may
be hard to know if your child is depressed or just moody. It's normal for a
child to be moody or sad from time to time. It's often just a part of growing
up. You can expect these feelings after the death of a loved one or pet, a move
to a new city, or a divorce.

But if these feelings last for weeks
or months, they may be a sign of depression.

If your child is just moody, he or she
probably doesn't need treatment. But if your child is depressed, he or she may
need medicine, counseling, or both to feel better.

It may also be
hard to know if your child's symptoms are caused by something other than
depression. Some medical problems can cause symptoms that look like depression.
Your child's doctor may do some tests to help rule out physical problems, such
as a low
thyroid level or
anemia, and other problems such as
anxiety,
attention deficit hyperactivity disorder (ADHD), or an
eating disorder.

Try or die by suicide. If your child has severe depression, he
or she is at a greater risk for suicide or attempted suicide. Some
warning signs of suicide might include substance abuse
problems or thoughts about death. Suicide attempts in
children younger than age 12 are rare.

Medicines called antidepressants are used to treat depression in
children and teens. They can help balance the chemicals in the brain that
affect your child's mood, and they can help reduce your child's
symptoms.

There are several types of antidepressant medicines. Fluoxetine (Prozac) is usually the first type of antidepressant
given. Another SSRI, such as citalopram (Celexa) or sertraline (Zoloft), may be
tried if fluoxetine doesn't help your child feel better.

Other
medicines may also be used. But the possible side effects of these medicines
are more serious than those of SSRIs. These other medicines include:

Your child will take pills or liquid medicine every
day for as long as he or she needs them. Your child may start to feel better
within 1 to 3 weeks after starting an SSRI. But it can take as many as 6 to 8
weeks to see more improvement. It's important that your child takes the
medicine as prescribed and keeps taking it so it has time to work.

If you have questions or concerns about your child's medicine, or if you don't
notice any improvement by 3 weeks, talk to your doctor. Your child may need to
try several different medicines to find one that works.

Your
child's medicine may cause side effects, but they will usually go away within
the first few weeks. Common side effects include:

Nausea.

Loss of
appetite.

Diarrhea.

Headaches.

Sleep
problems or drowsiness.

Feeling anxious or
grouchy.

Feeling dizzy or shaky (tremor).

There is also a small chance that your child might think
about suicide while taking antidepressants, especially during the first few
weeks of treatment.

A combination of fluoxetine and individual counseling often works
better than if only one kind of treatment is used. This is especially true if
your child's symptoms are severe. One study showed that after 12 weeks of treatment:3, 4

Out of 100 children who used medicine
and counseling, 71 were helped, and 29 were
not.

Out of 100 children who used only medicine, 60 were helped,
and 40 were not.

Out of 100 children who used only counseling, 43
were helped, and 57 were not.

This same study continued to follow these children. At 36 weeks:

Out of 100 children who used medicine
and counseling, 86 were helped, and 14 were
not.

Out of 100 children who used only medicine, 81 were helped,
and 19 were not.

Out of 100 children who used only counseling, 81
were helped, and 19 were not.

Over time, the children were helped equally by the three different treatments. But using both medicine and counseling reduced depression symptoms faster than either medicine or counseling alone.

Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle between depression and mania. If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously. But it can also be triggered by antidepressants. That is why it is very important to tell your child's doctor about any family history of bipolar disorder and to watch your child closely for signs of manic behavior.

FDA advisory. The U.S. Food and Drug Administration (FDA)
has issued an
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines.
Instead, people taking antidepressants should be watched for
warning signs of suicide, such as saying they are going to hurt themselves, talking or writing about death, or giving away their things. This is especially important
at the beginning of treatment or when doses are changed.

Studies
by the FDA have found that:

About 4 out of 100 children who used an
antidepressant had suicidal thoughts or behavior. This means that 96 out of 100
children who used antidepressants did not have suicidal thoughts or
behavior.5

The benefit of taking
antidepressants was greater than the risk of suicide in children and teens. For
some young people, taking an antidepressant can help ease the symptoms of
depression and may actually reduce the risk of suicide in the long run.6

There is a small chance that your child may think about suicide
while taking antidepressants.

Don't have your child
take medicine for depression Don't have your child
take medicine for depression

Your child sees a counselor for depression.

You
try to manage your child's symptoms at home with exercise, rest, healthy foods,
and support.

If your child's symptoms are mild to moderate, counseling or lifestyle
changes may be enough to help your child feel better.

Over time, children who are treated with only cognitive-behavioral therapy can be helped as much as children treated only with medicines.4

Your child
can avoid the side effects of medicine.

You don't have to pay for medicine.

If your child's
symptoms don't improve with counseling, you can decide later to try
medicine.

Your child's depression could get worse. He or she
may find other ways to feel better, such as by smoking or using alcohol or
illegal drugs.

If your child has severe depression, he or she is at
greater risk for attempting suicide.

Personal stories about deciding whether to use medicine to treat depression in children and teens

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Tyler has
always loved playing soccer, has had a lot of friends, and his grades have been
average. Since starting junior high school, though, Tyler has decided he is not
good enough to play soccer and he quit the team. He doesn't hang out with the
friends he used to have in grade school, is irritable most of the time, and
prefers to be alone. Sometimes he still jokes around with his younger
brothers and is able to laugh with them at pranks they pull on one another. His
grades have slipped a little, but he does do his homework daily. At a routine
checkup, his mother asked our doctor whether Tyler could be depressed. After
asking Tyler a few questions, the doctor said he didn't think so, but he
recommended that we watch him for further signs of depression. We've encouraged
him to join a few after-school activities. For now, we're taking a wait-and-see
approach.

Neal, father
of Tyler, age 13

Sarah has gone from an outgoing, happy
child to a quiet child who worries about everything. If Sarah is not crying,
she is irritable and moody. She has stopped all interest in her favorite
hobbies and doesn't seem to enjoy anything in her daily life. She sleeps a lot
and has gained more than 10 pounds over the past month. She's been acting this
way for around 6 months. I took Sarah to a child counselor, who said she has
mild to moderate depression. The counselor recommended that Sarah try an
antidepressant along with the counseling to try to improve her mood and lessen
the impact of the depression. I think the medication might help, and Sarah is
willing to try one or two medicines until the right one is found.

Tisha, mother of Sarah,
age 11

After Heather broke up with her boyfriend,
she cried all the time. She has a lot of friends who called to console her. She
thought that if she could only get his attention, the boyfriend would want her
back. My wife caught Heather going through our medicine cabinet looking for
pills that might make her sick, so we took her to the doctor who recommended a
therapist. Heather is seeing the therapist, but we've decided not to put her on
medicine. We think her problem came from this one situation with the
boyfriend, and after she learns some new coping skills, we hope she'll be better
able to handle future disappointments.

Adrien, father of Heather, age
16

Jerome got caught smoking at school, and I
suspected he had been drinking alcohol. Jerome was arguing with his teachers
and with me and said no one understands him. He would listen to music with
angry lyrics or sit alone in his room in the dark. I found a list Jerome wrote
identifying who should get his things should something happen to him. I dragged
him to a counselor, as he didn't want to go. The counselor said Jerome was
severely depressed. His father had been diagnosed with depression several years
ago. After a few sessions with the counselor, Jerome agreed to try an
antidepressant. His dad and I will help him stay on his medicine schedule
for as long as it takes for Jerome to get better.

Lasandra, mother of Jerome, age
15

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons for your child to take medicine for depression

Reasons for your child not to take medicine

My child wants to try medicine.

My child doesn't want to try medicine.

More important

Equally important

More important

My child's depression isn't improving with counseling alone.

I want my child to continue counseling, without medicine, at least for a while.

More important

Equally important

More important

I'm worried that depression is affecting my child's schoolwork and relationships with friends and family.

My child's schoolwork and relationships with friends and family don't seem to be affected.

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

My child taking medicine

My child NOT taking medicine

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Counseling may be enough to help my child feel better.

TrueThat's right. If your child's symptoms are mild to moderate, counseling or lifestyle changes may be enough to help your child feel better.

FalseSorry, that's not right. If your child's symptoms are mild to moderate, counseling or lifestyle changes may be enough to help your child feel better.

I'm not sureIt may help to go back and read "What other treatments are available?" in "Get the Facts." If your child's symptoms are mild to moderate, counseling or lifestyle changes may be enough to help your child feel better.

2.

If my child's symptoms are severe, he or she just needs to take medicine to get better.

TrueSorry, that's not right. If your child's symptoms are severe, a combination of antidepressants and counseling often works better than if only one of these treatments is used.

FalseThat's right. If your child's symptoms are severe, a combination of antidepressants and counseling often works better than if only one of these treatments is used.

I'm not sureIt may help to go back and read "What medicines can your child take for depression?" in "Get the Facts." A combination of antidepressants and counseling often works better than if only one of these treatments is used.

3.

I shouldn't worry if my child has been moody or sad for weeks.

TrueSorry, that's not right. It's normal for a child to be moody or sad from time to time. But if these feelings last for weeks or months, they may be a sign of depression.

FalseThat's right. It's normal for a child to be moody or sad from time to time. But if these feelings last for weeks or months, they may be a sign of depression.

I'm not sureIt may help to go back and read "How do you know if your child is depressed?" in "Get the Facts." If your child has been moody or sad for weeks or months, he or she may be depressed.

American Academy of Child and Adolescent Psychiatry
(2007). Practice parameters for the assessment and treatment of children and
adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11):
1503-1526.

Reinecke MA, et al. (2009). Findings from the Treatment for Adolescents with Depression
Study (TADS): What have we learned? What do we need
to know? Journal of Clinical Child & Adolescent Psychology, 38(6), 761–767.

U.S. Food and Drug Administration (2007).
Antidepressant use in children, adolescents, and adults.
Available online:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Depression: Should My Child Take Medicine to Treat Depression?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have your child take medicine for depression.

Don't have your child take medicine. Use counseling or home
treatment to help manage your child's symptoms.

Key points to remember

If your child's symptoms are mild to moderate, counseling or lifestyle
changes may be enough to help your child feel better. But if your child's
symptoms don't improve with counseling, you can add medicine to the
treatment.

If your child's symptoms are severe, a combination of
antidepressants and counseling often works better than if only one of these
treatments is used.

It's normal for a child to be moody or sad from time to time.
But if these feelings last for weeks or months, they may be a sign of
depression.

Stress, family problems, death of a loved one, or
trauma such as violence, abuse, or neglect can cause
depression.

The safety and long-term effects of medicines used to
treat depression in children and teens are not fully known. But experts believe
that the benefits of these medicines outweigh the risks.

If your
child needs to take medicine, help him or her to not feel ashamed about taking
it. Depression is a medical condition, not a character flaw or weakness.
Medicine can help your child feel better.

FAQs

What is depression in children and teens?

Depression is a serious mood disorder that can take
the joy from your child's life. It may occur when brain chemicals that affect
your child's mood get out of balance. Stress, family problems, or trauma such
as violence, abuse, or neglect can cause this to happen.

Depression
runs in families. Children and teens who have a parent with depression are more likely to have depression than children whose parents are not
depressed. As many as 2 out of 100 children and 8 out
of 100 teens have serious depression.1

How do you know if your child is depressed?

It may
be hard to know if your child is depressed or just moody. It's normal for a
child to be moody or sad from time to time. It's often just a part of growing
up. You can expect these feelings after the death of a loved one or pet, a move
to a new city, or a divorce.

But if these feelings last for weeks
or months, they may be a sign of depression.

If your child is just moody, he or she
probably doesn't need treatment. But if your child is depressed, he or she may
need medicine, counseling, or both to feel better.

It may also be
hard to know if your child's symptoms are caused by something other than
depression. Some medical problems can cause symptoms that look like depression.
Your child's doctor may do some tests to help rule out physical problems, such
as a low
thyroid level or
anemia, and other problems such as
anxiety,
attention deficit hyperactivity disorder (ADHD), or an
eating disorder.

What are the risks of not treating your child's depression?

Try or die by suicide. If your child has severe depression, he
or she is at a greater risk for suicide or attempted suicide. Some
warning signs of suicide might include substance abuse
problems or thoughts about death. Suicide attempts in
children younger than age 12 are rare.

What medicines can your child take for depression?

Medicines called antidepressants are used to treat depression in
children and teens. They can help balance the chemicals in the brain that
affect your child's mood, and they can help reduce your child's
symptoms.

There are several types of antidepressant medicines. Fluoxetine (Prozac) is usually the first type of antidepressant
given. Another SSRI, such as citalopram (Celexa) or sertraline (Zoloft), may be
tried if fluoxetine doesn't help your child feel better.

Other
medicines may also be used. But the possible side effects of these medicines
are more serious than those of SSRIs. These other medicines include:

What can you expect if your child takes medicine for depression?

Your child will take pills or liquid medicine every
day for as long as he or she needs them. Your child may start to feel better
within 1 to 3 weeks after starting an SSRI. But it can take as many as 6 to 8
weeks to see more improvement. It's important that your child takes the
medicine as prescribed and keeps taking it so it has time to work.

If you have questions or concerns about your child's medicine, or if you don't
notice any improvement by 3 weeks, talk to your doctor. Your child may need to
try several different medicines to find one that works.

Your
child's medicine may cause side effects, but they will usually go away within
the first few weeks. Common side effects include:

Nausea.

Loss of
appetite.

Diarrhea.

Headaches.

Sleep
problems or drowsiness.

Feeling anxious or
grouchy.

Feeling dizzy or shaky (tremor).

There is also a small chance that your child might think
about suicide while taking antidepressants, especially during the first few
weeks of treatment.

A combination of fluoxetine and individual counseling often works
better than if only one kind of treatment is used. This is especially true if
your child's symptoms are severe. One study showed that after 12 weeks of treatment:3, 4

Out of 100 children who used medicine
and counseling, 71 were helped, and 29 were
not.

Out of 100 children who used only medicine, 60 were helped,
and 40 were not.

Out of 100 children who used only counseling, 43
were helped, and 57 were not.

This same study continued to follow these children. At 36 weeks:

Out of 100 children who used medicine
and counseling, 86 were helped, and 14 were
not.

Out of 100 children who used only medicine, 81 were helped,
and 19 were not.

Out of 100 children who used only counseling, 81
were helped, and 19 were not.

Over time, the children were helped equally by the three different treatments. But using both medicine and counseling reduced depression symptoms faster than either medicine or counseling alone.

Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle between depression and mania. If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously. But it can also be triggered by antidepressants. That is why it is very important to tell your child's doctor about any family history of bipolar disorder and to watch your child closely for signs of manic behavior.

FDA advisory. The U.S. Food and Drug Administration (FDA)
has issued an
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines.
Instead, people taking antidepressants should be watched for
warning signs of suicide, such as saying they are going to hurt themselves, talking or writing about death, or giving away their things. This is especially important
at the beginning of treatment or when doses are changed.

Studies
by the FDA have found that:

About 4 out of 100 children who used an
antidepressant had suicidal thoughts or behavior. This means that 96 out of 100
children who used antidepressants did not have suicidal thoughts or
behavior.5

The benefit of taking
antidepressants was greater than the risk of suicide in children and teens. For
some young people, taking an antidepressant can help ease the symptoms of
depression and may actually reduce the risk of suicide in the long run.6

What other treatments are available?

If your
child's symptoms are mild to moderate, counseling or lifestyle changes may be enough to
help your child feel better.

There are different types of
counseling that may help your child.

Cognitive-behavioral therapy can help your child
understand why he or she feels a certain way. And it can help your child cope
with problems by changing the way he or she thinks and
behaves.

Interpersonal therapy can help your child build relationships with
others.

Problem-solving therapy can help your child find positive ways to deal with
problems.

Family therapy
provides a place for your child and the entire family to express fears and
concerns and learn new ways of getting along.

Play therapy engages children in activities that can help them cope
with their problems and fears.

Here are some things that you can do at home to help your
child feel better:

There is a small chance that your child may think about suicide
while taking antidepressants.

Your child's depression could get worse. He or she
may find other ways to feel better, such as by smoking or using alcohol or
illegal drugs.

If your child has severe depression, he or she is at
greater risk for attempting suicide.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about deciding whether to use medicine to treat depression in children and teens

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Tyler has always loved playing soccer, has had a lot of friends, and his grades have been average. Since starting junior high school, though, Tyler has decided he is not good enough to play soccer and he quit the team. He doesn't hang out with the friends he used to have in grade school, is irritable most of the time, and prefers to be alone. Sometimes he still jokes around with his younger brothers and is able to laugh with them at pranks they pull on one another. His grades have slipped a little, but he does do his homework daily. At a routine checkup, his mother asked our doctor whether Tyler could be depressed. After asking Tyler a few questions, the doctor said he didn't think so, but he recommended that we watch him for further signs of depression. We've encouraged him to join a few after-school activities. For now, we're taking a wait-and-see approach."

— Neal, father
of Tyler, age 13

"Sarah has gone from an outgoing, happy child to a quiet child who worries about everything. If Sarah is not crying, she is irritable and moody. She has stopped all interest in her favorite hobbies and doesn't seem to enjoy anything in her daily life. She sleeps a lot and has gained more than 10 pounds over the past month. She's been acting this way for around 6 months. I took Sarah to a child counselor, who said she has mild to moderate depression. The counselor recommended that Sarah try an antidepressant along with the counseling to try to improve her mood and lessen the impact of the depression. I think the medication might help, and Sarah is willing to try one or two medicines until the right one is found."

— Tisha, mother of Sarah,
age 11

"After Heather broke up with her boyfriend, she cried all the time. She has a lot of friends who called to console her. She thought that if she could only get his attention, the boyfriend would want her back. My wife caught Heather going through our medicine cabinet looking for pills that might make her sick, so we took her to the doctor who recommended a therapist. Heather is seeing the therapist, but we've decided not to put her on medicine. We think her problem came from this one situation with the boyfriend, and after she learns some new coping skills, we hope she'll be better able to handle future disappointments."

— Adrien, father of Heather, age
16

"Jerome got caught smoking at school, and I suspected he had been drinking alcohol. Jerome was arguing with his teachers and with me and said no one understands him. He would listen to music with angry lyrics or sit alone in his room in the dark. I found a list Jerome wrote identifying who should get his things should something happen to him. I dragged him to a counselor, as he didn't want to go. The counselor said Jerome was severely depressed. His father had been diagnosed with depression several years ago. After a few sessions with the counselor, Jerome agreed to try an antidepressant. His dad and I will help him stay on his medicine schedule for as long as it takes for Jerome to get better."

— Lasandra, mother of Jerome, age
15

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons for your child to take medicine for depression

Reasons for your child not to take medicine

My child wants to try medicine.

My child doesn't want to try medicine.

More important

Equally important

More important

My child's depression isn't improving with counseling alone.

I want my child to continue counseling, without medicine, at least for a while.

More important

Equally important

More important

I'm worried that depression is affecting my child's schoolwork and relationships with friends and family.

My child's schoolwork and relationships with friends and family don't seem to be affected.

American Academy of Child and Adolescent Psychiatry
(2007). Practice parameters for the assessment and treatment of children and
adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11):
1503-1526.

Reinecke MA, et al. (2009). Findings from the Treatment for Adolescents with Depression
Study (TADS): What have we learned? What do we need
to know? Journal of Clinical Child & Adolescent Psychology, 38(6), 761–767.

U.S. Food and Drug Administration (2007).
Antidepressant use in children, adolescents, and adults.
Available online:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

American Academy of Child and Adolescent Psychiatry
(2007). Practice parameters for the assessment and treatment of children and
adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11):
1503-1526.

Reinecke MA, et al. (2009). Findings from the Treatment for Adolescents with Depression
Study (TADS): What have we learned? What do we need
to know? Journal of Clinical Child & Adolescent Psychology, 38(6), 761–767.

U.S. Food and Drug Administration (2007).
Antidepressant use in children, adolescents, and adults.
Available online:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.